Transformation of the Cardiovascular Clinics in Japan　- How to Overcome Crisis Due to Changes in the External Environment.

The first percutaneous coronary intervention (PCI) was performed in September 1977, and after 1980 this minimally invasive treatment was established in Japan. To deliver this treatment to a larger population, a number of cardiovascular clinics emerged across the country in the 2000s, and the number of PCI cases performed has been steadily increasing, to >250,000 cases per year. In the early 2000s, a single catheterization unit was profitable, if it performed a certain number of treatments and was adequately staffed without excessive capital investment. In the late 1990s, the price of a balloon catheter medical device used for PCI was approximately JPY300,000, although the price was reduced to JPY32,000, almost one-tenth in price, in the April 2022 revision of the National Health Insurance. The reimbursement of the mainstream drug-eluting stent has also decreased from JPY421,000, when it was first introduced, to JPY136,000 currently. In addition, the consumption tax and reforms in working hours will have a major impact on clinic management. We present a history of cardiovascular clinics in Japan and their present and future positions under the variable external environment.

Several factors influencing the stability of extracted species in synergistic extraction of lanthanide(III) with pivaloyltrifluoroacetone and 2,2'-bipyridyl.

The stability constants and the hydration number of a complex between tris(pivaloyltrifluoroacetonato)lanthanide(III) (LnA(3)) and 2,2'-bipyridyl (B), LnA(3)B, and the complexation heat were determined across the Ln series by a solvent-extraction technique, Karl Fischer coulometry, and calorimetry, successively. The number of water molecules released from LnA(3) upon the complexation with B as well as the values of the stability constant increased along with increasing Ln atomic number to around Dy(III); via a maximum, it decreased. It is concluded that the largest stability constant of the complex of Ho(III) or this vicinity is derived from the strongest bond energy, due to the fitness between LnA(3) and B. This conclusion was supported by the trend of the variation of the entropy change as well as that of the hydration number across the Ln series.